HomeMy WebLinkAbout94-3997
BUILDING PERMITN~
CITY OF ZEPHYRHILLS Permit
(813) 788-6611
3997/3
Datl3
$'-;L/; -~~
~ ELECTRICAL PLUMBING MECHANICAL
PmpertyOwne' .~b~
~:~,:~d~~S; ;JZ- ,;-~i-" _ .. _ ..~
Sewer Conn
Water Conn:
Water Meter:
T.I.F.'s:
Zoning: ~~~ode:
Deso,;p,;on of wo;' / _ __. _. - q s,~ '"
Radon Gas:
NO OCCUPANCY BEFORE C.O.
FINAL
6" 9
DATE
Complete Plans, Specifications and Fee Must Accompany Application,
All work shall be performed in accordance with City Codes and Ordinances.
c.o.
DATE
Inspector
P~rmit Fe~~
Sltlnature~
Company
Address
Telephone#
Valuation or
Contract Price 6..s--o - tCT7:::1
City License Registration #
State Certified License#
ELECTRICAL
PLUMBING
MECHANICAL
Tp. Servo
Rough In
Meter Can
Canst. Pole
Pool
Pre-Meter
Final
Ftr.
Pre SLB
Lintel
FRM.
Insul. CL
WL
SLB
Tub Set
Water
Sewer
Final
Breakers
Ducts Insl.
Compressor
I=inal
Driveway
REINSPECTION FEES: When extra inspection trips are necessary due to anyone of the following reasons, a
charge of Fifteen and 00/100 Dollars ($15.00) shall be made for each trip for each trade:
a. Wrong Address
b. Condemned work resulting from faulty construction.
c. Repairs or corrections not made when inspection called.
d. Work not ready for inspection when called.
e. Permit not posted on job site.
f. Plans not at job site.
g. Work not accessible.
The payment of inspection fees shall be made before any further permits will be issued to the person owning
same.
SFc:nON '3 . T()~SIIlP 28 SOUW, RANGE 1.1 EA!H
PASCO COUN7Y. nOR/VA
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SIMMONS ~ BEALL, INC.
SURVEYING A MAPPING
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() CI.TY OF ZSPIIIRHILLS BUI.L1HNG DBPARTMBNT
..J c..o'lT Q 1 ~ ~
JOB LOCATION 3 C} 108lt m 8' to DOl000 w Loa p
OWNER
PARCEL 1. D. #
SHOW ALL EXISTING & PROPOSED STRUCTURES GI.VING DIMENSIONS & SETBACKS.
ALLEYWAY ACCESS FOR
GARAGE OR CARPORT -
15 FOOT SETBACK
REQUIRED.
UTILITY BUILDINGS
MUST SHOW SIZE &
FOUNDATION INFOR-
MA'fION.
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FRONT PROPERTY LINE
STREET mo ffi()w m~ LDOf
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APPLICAnON FOR PERHlT
CITY OF ZEPIIYRBILLS
BmLDDlG DEPAR11IENT
_'S _ 27 C-OI1 fl. i~ ~
OWNER'S ADDRESS ,-~9b8<.f m (-5 ct)'jouJob~ WOf
JOB ADDRFSS 39 08- L( rrl B.('\ "0 OuJOC;) LoOp
PHONE
g-/3 )~d 0]38'
LEGAL DESCRIPl'ION: toTeS)
BLOCK
SUBDIVISION
PARCEL 1.D.'
WORK PROPOSED:_New Construction _Addition _Alteration _Repair _Install
_Sign
_Hove
_D~lish
PROPOSED USE:
Single Fmlily
_H/F
_' of Units
_K/B
_ec-ercial
_Indust.
_Swia. Pool
Other
_Restaurant & Health Departllent Approval
BUILDING SIZE:
x
Square Feet.
Beight
RESIDENTIAL:
GOKKERGlAL :
AlTACH (2) PLOT PLOS & (2) SETS OF BUlLDDlG PLANS & (1) SET ENERGY FORKS.
ATtACH (3) SILTS OF BUILDING PLANS & (1) SET ENERGY FORKS.
PROPERTY SURVEY REQUIRED FOR ALL 8RW CONSTRUCTION.
PERKITS REQUESTED
_BUILDING
$
Valuation of Total Construction
_ELECIlUCAL
AIIP Service
Florida Power Corp.
W.R.E.C.
_ltEGBAlUCAL
$
Valuation of Hechanical Installation
_PLUPlBING
GAS
ROOFING
SPECIALTY
TYPE OF CONSTRUCTlOB: _Block _Fraae _Steel
Other
FINISHED FLOOR ELEVATIONS:
FI' .
IS PROJECT IN FLOOD ZONE AREA?
YES NO
..........................................
CON1'RAcroR SECTION
BUILDER GOHPAIIIY
State Gert. or Regist. ,
Signature City License Registration ,
..........................................
ELEGTRIGIAN GOHPABY
State Gert. or Regist. ,
SiPn~ture City License Registration ,
..........................................
PLUKBER GOfIPANY
State Gert. or Regist. I
Signature City License Registration ,
..........................................
IlEGIIAlUCAL GOHPAtiY
State Gert. or Regist. ,
Signature City License Registration ,
..........................................
OTHF.R GOKPANY
State Gert. or Regist. ,
Signature City License Registration ,
..........................................
APPLICATION APPROVED BY PERKIT OFFICER.
CONDITIONS OF PERMIT AFFIDAVIT
A. NOTICE OF DEED RESTRICTIONS
'l'be undersigned understands that this peIlit JaY be subject to 'deed restrictions' wbich lilY be lOre restrictive than City
regulations. !be undersigned assUJeS responsibility for COIpliance with any applicable deed reBtrictions.
B. UNLICENSED CONTRACTORS AND CONTRACTOR RESPONSIBILITIES
If the owner bas bired a contractor or contractors to undertake work, they JaY be required to be licensed in accordance with
Btate and local regulations. If the contractor is not licensed as required by law, both the owner and contractor laY be
cited for a liscll!leallor violation under Btate law. If the owner or intended contractor are uncertain as to wbat licensing
requirlllents JaY apply for the intended work, they are advised to contact the City of ZepbyrbillB Building Departlent, (813)
788-6611.
FurtherlOre, if the owner bas bired a contractor or contractors, be is adviBed to have the contractor(s) sign portions of the
'Contractor Sections' of this applicaticm for wbich they will be responsible. If you, as the owner sign as the contractor,
you are indicating that you, rather than the contractor, are reBponsible for the work. If the contractor wisbes you to sign
as contractor that laY be an indication that be is not properly licensed and is not entitled to peraitting privileges in the
City of Zepbyrbills.
C. TRANSPORTATION IMPACT FEES AND UTILITY CONNECTION FEES
D. CONSTRUCTION LIEN LAW (CHAPTER 713, FLORIDA STATUTES, AS AMENDED)
I certify that I, the applicant, have been provided with a copy of 'Florida's Construction Lien Law - lbIeOImer's Protection
Guide' prepared by the Florida Departlent of Agriculture and ConBUIer Affairs. If the applicant is BOIl!ODIl other than the
'owner", I certify that I have obtained a copy of the above described dOCUleDt and pn.ise in good faith to deliver it to the
"owner' prior to COIIeDCeleDt.
E. CONTRACTOR'S/OWNER'S AFFIDAVIT
I certify that all the inforaation in this application is accurate and that all work will be done in COIpliance with all
applicable laws regulating construction, loning, and land developent.
Application is bereby lade to obtain a peIlit to do work and inBtallation as indicated. I certify that no work or
inBtallation bas ~ced prior to issuance of a perlit and that all work will be perfoIJed to leet standards of all laws
regulating construction, City codes, loning regulations, and land developllent regulations in the jurisclictioo. I also
certify that I understand that the regulations of other goverDlleJltal agencies JaY apply to the intended work, and that it is
IY responsibility to identify wbat actions I lUst take to be in COIpliance. Such agencies include but are not lilited to:
II Departlent of BnvirOllleDtal Regulation - Cypress Baybeads, Wetland Areas and EnviroDlentally Sensitive Lands,
Water /Wastewater !reatlent
II Southwest Florida Water ManageleDt DiBtrict - WellB, CypresB BaybeadB, Wetland AreaB, Altering WatercourBes
II AIly Corps of BngineerB - Seawalls, Docks, Navigable Waterways
II Departlent of Health & Rehabilitative Services, Bnvil'Ollllelltal Health Unit - Wells, Wastewater !reatlent, Septic !mB
II US BnvirODJental Protection Agency - Asbestos abatllleDt
I also certify that, if fill laterial is to be used in Flood Zone 'A' or 'A,etc.', it is underBtood that a drainage plan
addressing a 'COIpeDSating vol_' will be sublitted wbich is prepared by a profesBional engineer registered in the State of
Florida prior to peIlit issuance.
A PeIlit iBsued shall be construed to be a license to proceed with the work and not as authority to violate, cancel alter, or
set aside any proviBions of the technical codes, nor sball iBsuance of a peIlit prevent the Building Official fIOl thereafter
requiring a correctioo of errors in plans, construction, or violations of any code. Every perlit iSBued shall becme invalid
unless the work aUthoriled by such peIlit is COIIeDCed within sillODthe of issuance, or if work autboriled by the perlit is
suspended or abandoned for a period of sil IODtbs after the tile the work is co.enced. One 90 day eltension of tile, laY be
allowed for the perlit with fee charge of $15.00. !be eltension shall be requested in writing to the Building Official. An
approved inspection lUSt be logged during each sillODth period, or the project will be considered abandoned.
WWIIG TO omR: YOUR FAILURE TO RECORD A NOTICE OF aJIIIBICDIIIT MAY RESULT II YOUR PAYIIG fiICE FOR IMPROVIIIIITS 'l'O YOUR
PROPBRTY. IF YOU IJIfDD 'l'O OBTAIN FIIlAlCING, CONSUL! IUft YOUR LDDIR OR II AT'l'ORDY BEFORE RECORDING YOUR DICE OF
C(IOlBNCBMBN'l'. JOBS UtmBR $2,500 IN VALUE 00 NOT tIlED fO RECORD AID POST A lINO'fICE OF C<IUIBHCBIIII'lI.
SIGllATURE: COIft'RAC'l'OR
SIGlATURE: (JIIIR OR AGm
SfA!E OF FLORIDA
coum OF
The foregoing instrument was acknowledged
before me this , 19____ by
SfAfE OF FLORIDA
coum OF
The foregoing instrument was acknowledged
before me this , 19_____ by
who is personally known to me or who has
produced
as identification and who did/did not
take an oath.
who is personally known to me or who has
produced
as identification and who did/did not
take an o~th.
(Signature)
(Signature)
(Name Typed, Printed or Stamped)
NOTARY PUBLIC
(Name Typed, Printed or Stamped)
NOTARY PUBLIC